Author: Zhao Guangnuo
seemingly ordinary hives unusual, but it makes itchiness, lose, and because lingering endlessly, like the grass on the fields, there is always a "wild fire, in spring." The more itchy, the more itchy, the more itchy, the vicious circle. What should I do if
has urticaria? Can I self-medicate? How to treat urticaria? Today, the health community interviewed Professor Zuo Yagang, deputy director of the Department of Dermatology of Peking Union Medical College Hospital, and asked him to solve the mysteries of urticaria.
01 Health: Is urticaria an allergic disease? What is its etiology and pathogenesis? Is allergen testing necessary for urticaria?
Professor Zuo Yagang : Urticaria is a localized edema reaction due to the expansion and permeability of small blood vessels in the skin and mucous membranes. It is clinically characterized as wind masses of varying sizes with itching, which may be accompanied by vascularity. Edema. Urticaria has two major types, acute and chronic. The course of acute urticaria is relatively short, usually within 6 weeks, and it is considered chronic urticaria if it exceeds 6 weeks.
The etiology and pathogenesis of these two types of urticaria are completely different: for acute urticaria, its cause is generally related to allergies, such as food, drugs, certain infections or mosquito bites, etc. may cause allergies and cause acute Urticaria.
The cause of chronic urticaria is much more complicated than acute urticaria. Some patients are related to allergies, and some have nothing to do with allergies. Clinically, it is divided into two categories: chronic spontaneous urticaria and chronic induced urticaria. Chronic spontaneous urticaria appears spontaneously without any cause; while chronic induced urticaria appears only under the induction of certain factors, such as cholinergic urticaria, which occurs during exercise, excitement, anger, anxiety, and fatigue It will only happen under circumstances; artificial urticaria, when human scratching, urticaria will appear on the skin; water-borne urticaria, which is the urticaria induced after contact with water; and some people are very sensitive to cold and heat. Urticaria can appear when cold or hot; pressure urticaria is also prone to urticaria in places compressed by belts, bras, etc. In addition, the following reasons are also related to urticaria:
infection factors, such as Helicobacter pylori infection, Helicobacter pylori as a complete antigen can cause the body's allergy to produce IgE antibodies, regulate mast cells and Basophils release histamine and other inflammatory mediators, which are involved in the occurrence and development of chronic urticaria; secondly, it is related to endocrine disorders, such as endocrine disorders in menopausal women, which can easily induce urticaria. Patients with thyroid disease are also prone to urticaria.
Generally speaking, the etiology of urticaria is very complex, 70-80% of patients cannot find the cause at all, so there are very few factors related to chronic urticaria that are really allergic.
Generally speaking, urticaria, especially chronic urticaria, generally does not need to be checked for allergens, but there is a family history of allergies, allergic diseases, such as allergic rhinitis or allergic asthma. These people may need to check for allergens. These things are in a highly sensitive state.
02 Health: Is urticaria related to low immune function? What are the hazards of chronic urticaria?
Professor Zuo Yagang: Acute urticaria is an allergic reaction, and most allergic reactions are hyperimmune function rather than weakened immune function, so it has nothing to do with weakened immune function. It is the body's immune regulation function that has problems. Urticaria is prone to appear when dysfunction.
Chronic urticaria directly affects the quality of life of patients, with repeated erythema and itching all over the body, work, life, and sleep will be greatly affected. In addition, some chronic urticaria can easily be combined with chronic allergic rhinitis or allergic asthma.
At the same time, some chronic urticaria are prone to acute urticaria. Some people may experience difficulty breathing, drop in blood pressure, and even throat edema, which will threaten the health and even life of the patient.
03 Health: What symptoms of urticaria must go to the hospital? Under what circumstances can I self-medicate?
Professor Zuo Yagang: First of all, for acute urticaria, the onset of acute urticaria is very fast, the area of the rash is relatively large, and there will be difficulty breathing, suffocation, abdominal pain and even blood pressure drop. In this case, you must go to the hospital quickly treatment.
For chronic urticaria, there are two situations: if
does not affect the quality of life of the patient, you can temporarily not go to the hospital,Take some drugs such as loratadine and cetirizine for control. These drugs are relatively safe. However, we do not recommend that patients take one type of drug blindly and for a long time, because the body is prone to tolerance after taking one drug for a long time. Originally one pill can last for two or three days, but one pill may only last for one day. Up. Therefore, it is recommended to go to the hospital and have a doctor to guide the medication and switch to other medications. At the same time, doctors will also conduct blood tests, liver and kidney function tests, to prevent rare adverse reactions. If
obviously affects the patient’s quality of life, such as unbearable itching, and unable to sleep or work normally, you need to go to the hospital for treatment.
04 Health: What are the treatment methods for urticaria?
Professor Zuo Yagang: For some mild acute urticaria, such as only some erythema and wind masses, no symptoms such as suffocation, breathing difficulties, blood pressure drop, etc., use second-generation antihistamines, loratadine , Cetirizine is a commonly used drug. If the condition is relatively serious, and symptoms such as blood pressure drop, difficulty breathing, and laryngeal edema, you need to go to the hospital in time, take hormone drugs orally or intramuscularly, and use epinephrine if necessary.
First-line treatment of chronic urticaria: For chronic urticaria, the first-line treatment is also a second-generation antihistamine. The most common ones are loratadine and cetirizine. After the second-generation antihistamines take effect, the dose can be gradually reduced. Do not stop the drug immediately, even if the symptoms are relieved. Generally speaking, antihistamines for chronic urticaria take at least one month. In fact, most patients cannot be relieved in one month. The course of treatment is related to the length of the disease. The longer the illness, the longer the course of treatment, so there is no fixed pattern for the duration of treatment.
second-line treatment of chronic urticaria:
when the first-line treatment is not effective, second-line treatment should be used. There are two types of second-line treatments, one is combination therapy. The first combination of
is a combination of first-generation antihistamines and second-generation antihistamines. First-generation antihistamines such as diphenhydramine, chlorpheniramine and ketotifen. Relatively speaking, these drugs have more adverse reactions and are prone to drowsiness. But it also takes advantage of this to allow the patient to rest well at night. The second-generation antihistamines have relatively low drowsiness, so we will combine the first and second generations. The second combination is a combination of H1 receptor antagonists and H2 receptor antagonists. The first-generation and second-generation antihistamines we have just mentioned all refer to H1 receptor antagonists, in addition to H2 receptor antagonists. For example, ranitidine and famotidine are all H2 receptor antagonists, so we can combine H1 and H2, which is also a joint solution.
The second type of second-line treatment is to increase the dose. For general urticaria, you can take orally according to the instructions (one tablet per day). If the condition cannot be controlled, you can double it. Take two or even four tablets a day. The current maximum dose can be taken up to 4 times the normal dose. But it needs to be explained that this 4-times-dose treatment method must be used under the guidance of a doctor to ensure safety, and it is an off-label medication, and the patient must be informed.
Third-line treatment of chronic urticaria:
What if the second-line treatment is not effective?
will use third-line treatment, which is to use some drugs with stronger effects and larger side effects, such as the most commonly used immunosuppressants. The traditional Chinese patent medicine Tripterygium wilfordii polyglycosides has immunosuppressive effects. Cyclosporine is also a common immune agent and is effective for chronic urticaria. There is also a class of drugs called biological agents---omalizumab, which has developed rapidly in recent years. This drug is a targeted therapy drug, which targets the IgE antibody that causes urticaria and is effective for certain intractable urticaria.
05 Health: Are there any side effects from the use of drugs in the treatment of urticaria?
Professor Zuo Yagang: The first-line antihistamines are relatively safe and do not harm patients. However, some patients should also pay attention. For example, loratadine is mainly metabolized by the liver, so patients with liver disease should be careful and need to check liver function regularly. Cetirizine is mainly metabolized by the kidneys, so it is best not to use it if you have kidney disease. If the patient is in good physical condition, it is enough to monitor the liver and kidney function regularly.
However, the immunosuppressant in the third-line treatment has relatively large side effects. If taken for a long time, white blood cell decline and liver and kidney function damage are prone to occur, So be sure to regularly check blood. Patients with hypertension and kidney disease should not use cyclosporine.
Therefore, when choosing different drugs, we must monitor the adverse reactions of this drug.
06 Health: Can chronic urticaria be cured after all? Are there any cases that cannot be cured? Professor
Zuo Yagang: Chronic urticaria is difficult to cure. Most patients need a long course of treatment, which may be six months, one year, two years or even longer. So some experts believe that this disease can be cured by itself, but it cannot be cured because some patients cannot find the exact cause. For example, urticaria caused by a menopausal woman, due to endocrine disorders, will heal after menopause urticaria, so this condition can heal itself without treatment.
For another example, some people are allergic to the stent in the body. If the stent is not removed, it is impossible to cure it.
Because the cause of urticaria is too complicated, it is difficult to cure this disease.
07 Health: Usually, patients are especially prone to itching. How can he relieve them quickly? Are there any tricks and the like?
Professor Zuo Yagang: The main symptom of this disease is itching. There are a few tips to try. First, divert attention. When itching occurs, don't be troubled by it. You always want to stop itching by scratching. The result is that the more you scratch, the more itchy, the more itchy you want to scratch, forming a vicious circle, so the goal of stopping itching can be achieved by diverting attention. .
Second, you can apply cold water. When itching occurs, you can use a cold towel to apply cold locally. Be careful not to apply it all over the body. Be careful to catch a cold or blow on an electric fan to relieve itching.
Third, calamine lotion and calamine menthol lotion can also be used externally, these drugs will significantly reduce itching.
08 Health: What should I pay attention to when I get urticaria?
Professor Zuo Yagang: If it is water-borne urticaria, you must be careful not to touch water; for cholinergic urticaria, do not stress, fatigue or exercise to avoid these predisposing factors. Because urticaria is related to diet, especially after eating seafood, chili, lamb, and drinking alcohol, it is easy to aggravate urticaria. If combined with Helicobacter pylori or thyroid disease, treatment should also be carried out at the same time. In addition, pay attention to the rules of life and do not stay up late.
09 Health circles: After getting urticaria, do you recommend going to the hospital first or taking your own medicine to relieve the symptoms?
Professor Zuo Yagang: If it is acute urticaria, it is recommended to go to the hospital, because acute urticaria comes very fierce and may be mild at first, but shortly there may be breathing difficulties and blood pressure drops. If
is a well-diagnosed chronic urticaria, which does not have much impact on life, you can go to the pharmacy to buy medicine for control. If you are not sure if it is urticaria, it is recommended to go to the hospital and be guided by a doctor.
If chronic urticaria suddenly worsens, you need to go to the hospital at this time.
During the treatment period, the dosage of the drug should be adjusted. For example, at the beginning, it can be taken according to the instructions every day. After the condition is stable for a period of time, the interval between the medications can be extended to take one tablet for two days, or even one tablet per week, striving for the minimum maintenance The dose maintains a stable condition.
Here we need to remind the majority of patients, remember not to take the medicine intermittently, take the medicine when you get sick, and stop the medicine when you get better. This is not advisable, and it will cause the illness to prolong. In addition, try not to use hormone therapy, because many patients are eager to treat the disease and eager to control the condition, and some irresponsible doctors in the rivers and lakes will give patients hormone therapy.
[Profile of the expert]
Zuo Yagang, deputy director of the Department of Dermatology, Peking Union Medical College Hospital, postgraduate tutor
Member of the Standing Committee of the First Committee of the Dermatology Branch of China Association for International Exchange and Promotion of Health Care, Vice Chairman and Secretary-General of the Second Committee, China Vice Chairman of the 5th Committee of the Autoimmune Disease Committee of the Dermatology Branch of the Association of Physicians, Member of the 13th Youth Committee of the Dermatology Branch of the Chinese Medical Association, Member of the 14th Experimental Group, Beijing Medical Association Dermatology Branch Vice Chairman of the 3rd Youth Committee, Vice Chairman and Secretary of the 3rd and 4th Professional Committee of Sexually Transmitted Diseases Prevention and Treatment of the Chinese Society of Sexuality, member of the Standing Committee of Dermatology Branch of Chinese Society of Chinese Medicine Information, and Deputy Chairman of the Beauty and Weight Loss Professional Committee of Beijing Acupuncture and Moxibustion Society.
has been fromHe works in dermatology, and his research direction is autoimmune diseases. In 2010, he was awarded "Outstanding Talents in the New Century" by the Ministry of Education. In 2014, he was awarded "Outstanding Young and Middle-aged Physician" by the Dermatologist Branch of the Chinese Medical Doctor Association. ".
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